I implore all physicians to watch the film Tipping the Pain Scale. Invited by a friend to view from the perspective of recovery, I accepted in support and out of curiosity for the proposed approach to the treatment of pain. As an osteopathic neuromusculoskeletal medicine physician, this is the chief complaint of many patients seeking care, often addressed with hands-on treatment considering structure and function and the unity of body, mind, and spirit. My experience of the film happened at the cellular level as it spoke to every path of experience in my life, personally and professionally, and I invite all physicians to take the time to watch, to listen, to understand, and to consider approaching pain with a broadened perspective.
Pain exists. Pain is experienced in the body. Pain is sourced from many places. Pain can be masked. Pain can be treated. Pain can be ignored. Pain will persist if not addressed. Pain requires time, attention, care, and a willingness to truly look at cause.
Medicine is full of pain—found in the symptoms and diagnoses of patients, yes, but also in the experience of those practicing medicine. Perhaps our reason for entering medicine, to the painful experiences along the way, to the unspoken pain that leads many to leave their careers, overuse substances, disconnect from communities, and, in ever-escalating numbers, take their own life, pain permeates the medical profession.
High-functioning humans with countless compensatory skills can sometimes overcome, and more often simply override, the truth of their experience. We know, though, that this is not sustainable, and while this film has enormous merit for how we approach patient care, community compassion, policy change, and transformation on many levels, it has even greater power, specifically for the practice of medicine, to influence how we are caring for ourselves. If we do not change our own understanding of trauma, pain, and the true depth of impact on physical, mental, emotional, spiritual, and energetic health, we will not have the resolve or reserve to provide care in a sustainable way to our patients or to take up the necessary and daunting task of systemic change.
Substance use among physicians is simultaneously normalized and taboo. Social consumption of alcohol, which often lands in the overuse category, is seen as deserved relief from the stressors of work and life in general. Perhaps because changing those stressors seems next to impossible, the simpler solution is to ease the pain of the experiences. When overuse is acknowledged and help is sought, physicians often face extreme penalties, stigma, and even career-altering or ending consequences. This is a glimmer of the hazards of a system that is not designed to understand the source of substance abuse, nor acknowledge the disease of addiction as one that needs more questions, connection, and compassion than judgment, isolation, and punishment.
Helping patients understand that pain is felt in their body but often sourced from other places, experiences, and emotions is a delicate dialogue, as many will assume they are being dismissed, that their pain is not being acknowledged as real. Reiterating that the pain is very much real, and that discovering the true source is critical in the path of progress toward resolution. I experienced this directly through a painful and debilitating injury of my own muscular system—a tear of transversus abdominis. This was a clear, mechanical source of pain—however, it was more emphatically a call to examine my life on every level, through the process of which I was able to see and eventually make significant changes to address the disease I had been experiencing for a lifetime.
Prior to this injury, I had already discontinued my relationship with alcohol. One I never intended to initiate, having grown up the child of a recovering alcoholic and knowing the risks of consumption for me. However, loneliness, overwhelm, trauma from childhood and those endured through my own medical education and training, led me to use alcohol to mask, numb, and survive my life, for more than 15 years. When I stepped out of alcohol use and back to my original plan of lifetime abstinence, I could no longer ignore the pain. I substituted the numbing with overworking, which I see in so many of my colleagues, and this injury forced me to stop. And in that stillness, I had to face difficult truths. The physical pain of the tear is worse than anything I have ever experienced, but it is negligible in comparison to the brutality of truly uncovering what had been locked in my heart for a lifetime.
Four years of intensive coaching, counseling, introspection, career transitions, divorce, financial hardship, and relationship shifts have rocked me to my core and invited transformation. Through the grace of kindness and compassion from friends, family, and colleagues, I have arrived, for the first time, to a place of unconditional self-love, awareness of experience, and willingness to face the most painful parts of my story, knowing that it is in facing those truths that their power to control my life is released.
We all do not have the same path of pain resolution. The journey might not be so turbulent for some. Having worked with more than 500 physicians over the course of this same interval of time, honoring the gift of coaching and teaching on the path of healing, I know that I am not alone and extend to all of you that you are not alone either. Reach out, look within, consider the source of pain for yourself, for your patients, for your partners, for your children, for your colleagues, for your communities. Not because you must take it all away, but because when we are willing to look, we create the space for change to happen at the cellular level and invite recovery to begin.
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Amelia L. Bueche is an osteopathic physician and founder, This Osteopathic Life.
